Exemptions to Anthem’s ED Policy
Anthem will not deny an ED claim based on the prudent layperson standard if certain conditions apply.
MA Gets Better Outcomes Despite Sicker Enrollees: Study
July 10—Contrary to general belief, Medicare Advantage (MA) plan enrollees are initially sicker than those in fee-for-service (FFS) Medicare, according to new research. And once enrolled, MA beneficiaries get better care at a lower cost.
Pilot to Offer APM Bonuses to Physicians in Medicare Advantage
July 3—Medicare plans to launch a pilot—as soon as this year—to allow physicians paid through Medicare Advantage value-based arrangements to qualify for the same bonuses as those working in advanced alternative payment models.
Definition of “Employer” under Section 3(5) of ERISA – Association Health Plans Final Rule Executive Summary
This document summarizes the Employee Benefits Security Administration's Association Health Plans final rule, published in the June 21, 2018, Federal Register.
Rejecting Hospital Concerns, Administration Expands Association Plans
June 19—Despite calls from major hospital groups to drop a proposed expansion of association health plans (AHPs), the Trump administration has finalized those rules.
June 4-8: High-Deductible Health Plans Draw Congressional Scrutiny
May 31—Amid record-breaking enrollment in high-deductible health plans (HDHPs), a congressional panel plans to examine their growth and consider policies to bolster health savings accounts.
How MA Plans Are Changing VBID Approaches
May 18—Medicare Advantage (MA) plans are evolving their approaches in the expanding Medicare pilot for value-based insurance design (VBID).
A Look at Two Blues’ Distinct Approaches to Changing the Healthcare Model
May 16—Two dominant not-for-profit health plans—both Blue Cross insurers—are moving aggressively in very different directions.
Ask the Experts: Credit Balances
How do other Florida hospitals initiate and work credit balances?
New MA Rules Benefit Provider-Sponsored Plans
April 18—Recently announced Medicare Advantage (MA) rates and rule changes could help sometimes-struggling provider-sponsored plans improve their performance.